Script concordance test: Insights from the literature and early stages of its implementation in osteopathy

Osteopathic pre-registration education aims to produce competent autonomous practitioners who are capable of dealing with and mastering the uncertainty of clinical practice. The students' preparedness for clinical practice is typically assessed using high fidelity long case exams, i.e., clinical competence assessments using real patients in a real clinical setting. In this paper, we critically review relevant literature concerning the validity, reliability and underpinning educational theory of the Script Concordance Test (SCT), and describe the development, implementation and initial critical evaluation of this assessment tool in the osteopathy programme at Oxford Brookes University. The SCT is an assessment tool aimed at assessing clinical reasoning in the context of uncertainty, which is being increasingly used as an assessment strategy in the field of medical education. Despite its limitations, we believe that the SCT is a useful addition to assessing clinical reasoning in osteopathy, particularly in situations of clinical uncertainty. It has the potential to effectively assess the students' diagnostic reasoning, evaluation of risk and patient safety, and ethical aspects of osteopathic care. Critically, it provides an important vehicle to assess the students' preparedness for autonomous clinical practice using a standardised format.